Zimbabwe : final country report

SEATS II continued the momentum gained in Zimbabwe under SEATS I (1989-94), maintaining its collaboration with municipalities, the Ministry of Health (MOH), the Zimbabwe National Family Planning Council, and NGO service providers and managers. To support USAID and host government goals of reducing the national fertility rate and increasing the sustainability of family planning (FP) programs, SEATS supported and strengthened municipal-level FP training capacities; expanded the availability and use of long-term FP methods; and addressed constraints and opportunities for service delivery in underserved areas and for special populations. Key activities included: integrating services to achieve a broader reproductive health (RH) approach; focusing on youth and groups with special needs; implementing an overarching quality improvement component; and developing underutilized service provider capacity. During the past 5 years, SEATS II has worked with the public and private sectors, cooperating agencies, and international partners to implement six subprojects: (1) Bulawayo FP service delivery -- support for quality improvement and training; (2) expanded access to voluntary surgical contraception (VSC) in Bulawayo -- an urban initiative subproject; (3) Chitungwiza FP services -- comprehensive training for quality improvement; (4) Gweru FP service delivery -- support for quality improvement and training; (5) Gweru youth RH project; and (6) expanding FP and sexually transmitted infection services by private nurses and midwives in Zimbabwe. As a result of these and other SEATS-supported activities (e.g., those at the regional level), clinical and provider service delivery points have expanded and improved. To improve service quality, each subproject participated in the Maximizing Access and Quality (MAQ) study and developed action plans to introduce and incorporate quality of care awareness and techniques. SEATS has also worked with the subprojects to integrate several of its special initiatives into their services. Overall, SEATS successfully increased access and improved quality in most sites in the Zimbabwe subprojects, as follows: A total of 2,082 people were trained in a wide range of FP topics; on average, couple years of protection (CYP) increased 31% in the subprojects; a total of 221,939 CYP were generated; in about a 3-year period 110,143 new users were served; and method mix was broadened, with long-term methods and condoms increasing in popularity, thereby reducing Zimbabwe"s heavy dependence on pills. Details on the specific subprojects are provided in the final subproject reports. Overall lessons learned are as follows: (1) Comprehensive, multiple intervention approaches can meet the needs of many audiences, including youth and other special segments of the population. While access to contraception and information is not sufficient to address the root causes of risk behavior, it is an essential step. (2) By institutionalizing a client focus in health facilities, city health departments and private providers can help build support for services, encourage and facilitate utilization of services, and help improve service quality. (3) Introducing training fees for non-city health department providers in newly established municipal training centers (e.g., Bulawayo) can generate income for the center and allow training of non-city health department service providers at a reasonable cost. (4) Involving the community (e.g., parents, youth and community leaders) in program design, implementation, and evaluation is highly acceptable to those being served and helps promote youth-friendly services. When youth respond favorably to peer educators and youth facilities, RH service utilization can increase. In Gweru, the youth center, while very popular, has to date been used mostly for recreation, though the city council is optimistic that the use of its RH services will increase. (5) Midwives as integral, trusted members of the community, working in both rural and urban settings, are well positioned to serve hard-to-reach populations and isolated or underserved areas. Private midwives are highly motivated to provide quality services, as their reputation and livelihood depend on it.